Review methods Studies of any design that assessed the health and socioeconomic impacts of major multi-sport events on the host population were included. We excluded studies that used exclusively estimated data rather than actual data, that investigated host population support for an event or media portrayals of host cities, or that described new physical infrastructure. Studies were selected and critically appraised by two independent reviewers.

Results Fifty four studies were included. Study quality was poor, with 69% of studies using a repeat cross-sectional design and 85% of quantitative studies assessed as being below 2+ on the Health Development Agency appraisal scale, often because of a lack of comparison group. Five studies, each with a high risk of bias, reported health related outcomes, which were suicide, paediatric health service demand, presentations for asthma in children (two studies), and problems related to illicit drug use. Overall, the data did not indicate clear negative or positive health impacts of major multi-sport events on host populations. The most frequently reported outcomes were economic outcomes (18 studies). The outcomes used were similar enough to allow us to perform a narrative synthesis, but the overall impact of major multi-sport events on economic growth and employment was unclear. Two thirds of the economic studies reported increased economic growth or employment immediately after the event, but all these studies used some estimated data in their models, failed to account for opportunity costs, or examined only short term effects. Outcomes for transport were also similar enough to allow synthesis of six of the eight studies, which showed that event related interventions—including restricted car use and public transport promotion—were associated with significant short term reductions in traffic volume, congestion, or pollution in four out of five cities.

Conclusions The available evidence is not sufficient to confirm or refute expectations about the health or socioeconomic benefits for the host population of previous major multi-sport events. Future events such as the 2012 Olympic Games and Paralympic Games, or the 2014 Commonwealth Games, cannot be expected to automatically provide benefits. Until decision makers include robust, long term evaluations as part of their design and implementation of events, it is unclear how the costs of major multi-sport events can be justified in terms of benefits to the host population.

Footnotes

Contributors: Sally Macintyre had the original idea for the review. GMcC, ST, and HT designed and planned the review. GMcC was the lead reviewer and ST was a co-reviewer. Both reviewers undertook study selection and appraisal, and data extraction and tabulation. HT provided advice on each aspect of the review methods. GMcC, ST, HT, JS, PH, DSM, and LB formed a review advisory group. JS and GMcC were responsible for searching the grey literature, and VH was responsible for database searching. Mary Robins, the staff at Glasgow University Library, and the staff of the Public Health Resource Unit library at NHS Greater Glasgow and Clyde assisted in the retrieval of articles. Adam Brown and Susie Palmer provided additional grey literature. Nigel Rice and Ken Gibb gave advice on the appraisal of economic studies. Erik Lenguerrand and Elena Sautkina assisted with translation of foreign language articles. GMcC, ST, and HT synthesised the data, and GMcC wrote the manuscript. All the authors critically revised the manuscript and approved the final version. The views expressed here are those of the authors and do not necessarily reflect the views of the Medical Research Council, the Chief Scientist Office at the Scottish Government Health Directorate, the University of Glasgow, or the NHS. GMcC is the guarantor.

Funding: GMcC, ST, HT, VH, and LB were funded by the Chief Scientist Office at the Scottish Government Health Directorate as part of the Evaluating Social Interventions programme at the Medical Research Council Social and Public Health Science Unit (wbs U.1300.00.002.00024.01). JS works as part of the Public Health Resource Unit at NHS Greater Glasgow and Clyde. PH and DSM are funded by the University of Glasgow. DSM is also partially funded by NHS Greater Glasgow and Clyde. This study was not commissioned and no project specific funding was received. The funders had no role in the study design; data collection, analysis, and interpretation; writing the manuscript; or the decision to submit the research for publication.

Competing interests: GMcC is a member of the Scottish Socialist Party and was previously involved in a project to have a velodrome built in the west of Scotland. All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: (1) No financial support for the submitted work from anyone other than their employer; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No non-financial interests that may be relevant to the submitted work.